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Syphilis - definition, symptoms and therapy

Syphilis - definition, symptoms and therapy

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Since the end of the 15th century, syphilis, also known as French sickness, epidemic of plague, hard chick or syphilis (venerea), has haunted Europe. The Spanish explorers of America abducted the highly contagious Treponema pallidum bacterium from the New World. Syphilis is a sexually transmitted disease like HIV, gonorrhea or genital herpes.

The pathogen enters the body through the mucous membrane or skin cracks, especially during sexual intercourse. The risk of infection in anal sex is even greater than in vaginal sex. It is also possible to be infected through blood contact such as blood transfusions, skin contact with infected people or from pregnant women to the unborn baby. But that rarely happens in Germany.

A forgotten illness

Most people perceive the pleasure epidemic, like plague or smallpox, as a historical plague, which made famous people like Oscar Wilde and Friedrich Nietzsche sick. Syphilis is still widespread worldwide, and infections have been increasing again in recent decades - and since 2010 in Germany as well. In contrast to the early modern era, STD can be treated very well today.


Early complaints only occur in about 50 percent of those affected. A typical ulcer then forms where the pathogen entered the body - painless and hard around the edges. Then the surrounding lymph nodes swell. In the next stage, the bacterium spreads throughout the body through the blood and lymph. This is followed, among other things, by fever, rash and hair loss.

After this second stage, if left untreated, syphilis can either heal itself or persist for years. Sometimes the third stage begins, and now it's getting dangerous. Decades after infection, the bacterium can cause severe organ damage. If it penetrates the brain or spinal cord, neurosyphilis develops. This leads to severe nerve damage, mental disorders and the loss of mental abilities. In the past, these symptoms were called "syphilitic bullshit". The last time one of the greatest thinkers of the 19th century was characterized by neurosyphilis: Friedrich Nietzsche spent his retirement in confusion.


The ulcer and swollen lymph nodes in the first phase, combined with a rash in the second, already indicate the disease. With blood tests and pathogen detection in the laboratory, the diagnosis is certain. The laboratory doctor must now report the illness and report the case to the Robert Koch Institute - without the patient's name.

What should patients do?

Even if it is difficult, embarrassing and means contact with people with whom the affected person has concluded: It is essential that the sick people inform their sexual partners about their illness, and they should be examined by a doctor and, if necessary, treated. If the disease has already progressed, those affected must also inform previous partners.

Why is syphilis called French sickness?

The author Claudia Stein wrote a book about the outbreak of syphilis in Augsburg in the early modern period, and exemplified how the disease got its somewhat strange name French illness. According to Stein, the Augsburg Chronicle of Hector Mülich highlights the new disease as an event of the year in 1495: “The time of jars is ain posse plag (bad plague) in this country come with the big, flatter ones (with the big leaves) that was called the Frantzosen, umb that [the kranckhait] rose first in France; and then came all over the world. ”

According to Mülich, the disease was called French sickness because it first appeared in France. A common reaction to new diseases becomes clear: the neighbor is to blame. In addition, contemporaries considered syphilis a punishment from God. Mülich also claims that the illness occurred among the mercenaries of King Charles VIII (1483-1498) of France, namely in 1494. This even happens in time, since Columbus had returned from the first trip to America. It was clear among Germans, however, that the French had spread them. The disease was called, among other things, "French pox" or Latin "Gallicus disease".

Initially, nobody in Germany made a connection between the outbreak of the disease in Europe and the discovery of America in 1492. Why also: The scapegoat was found with the "dissolute French". The Italians also attributed the disease to the French. The French did it the other way round and called the "French disease" as "Neapolitan disease". The Italians were to blame for them. Finally, in Poland the new epidemic was given the name "German disease" and the Russians called it "Polish disease". Syphilis soon had over 400 names across Europe.

However, Gonzalo Fernández de Oviedo y Valdés (1478-1537) said that members of the Columbus team were infected with syphilis by American indigenous people. This finding was supported by the famous Dominican Bartolome de las Casas and the doctor Ruy Diaz de Isla. De las Casas knew syphilis victims in America, and the medical doctor De Isla had treated the first known victim in Europe in Barcelona.

Today there is broad agreement in medical history: when Columbus' team came back from his first trip to America in 1492, he brought the pathogen with him. Syphilis first spread to Spain. When Spanish soldiers intervened in the fighting between Italians and French in Naples, the French and Italians became infected and spread the disease in their home countries. Charles VIII's army withdrew from the siege of Naples and brought the plague to France. From a German perspective, the term “French sickness” is understandable.

The sinful lust

It quickly became clear that sex and illness were related - a feast for the Catholic clergy in the Renaissance. In Italy and France in particular human liberation had taken place, and centers of Renaissance scholars such as Florence were seen as reactionary priests as the new Babylon.

The sick became outlaws, having contracted the plague through their sin. Even more: Nobody knew anything about bacteria and infection. Thus, contemporaries rightly recognized that the exercise of physical pleasure and the outbreak of syphilis had something to do with each other, but declared this connection as God's punishment. God therefore punished sinners for their sin of lust.

The sick were marginalized and had to hang around outdoors, sleep under bridges or in the forest. Customs officers checked them at the city limits and forbade them to beg, and innkeepers were forbidden to let them in. Surgeons and barbers were not allowed to treat them and bathers were not allowed into the baths.

The church celebrated success: the popular bathing rooms, which were often also brothels, were lost to customers because bathers were afraid of contracting the disease. A brief period of physical freedom gave way to prudery out of fear. 1500 new plague houses were built in Germany - the "French houses".

Syphilis spread across the population. At first she was mainly known among mercenaries and prostitutes, but soon rulers also suffered from her: Charles VIII, Franz I, Henry VIII or Ivan the Terrible, Cardinal Richelieu, Peter the Great and Catherine the Great. Artists such as Ludwig van Beethoven, Heinrich Heine, Gauguin, Franz Schubert, Goya and Maupassant were among the victims.

The magic agent from the New World

The plague had come from America and contemporaries believed there was an antidote there too. In the 16th century, Hispania's treasurer Gonzales imported the guaiac wood to Europe, claiming that it had cured his syphilis. We now know that in some cases syphilis goes away on its own.

The Guiacum officinale grows in the Antilles as well as in Venezuela, Colombia, Guiana and Panama. The related Guiacum sanctum, however, comes from the West Indies. The Europeans were ecstatic. At last there seemed to be a gentle remedy for the disease. Previously, the therapy consisted of mercury ointments and sweating cures, whereby poisoning with mercury often killed the sufferers faster than the "French disease".

Doctors praised the new miracle cure, the Fugger in Augsburg earned another golden nose with the guaiac wood trade, because Emperor Karl V had given them the privilege of trading in the "holy wood". The sick took in the laboriously grated wood as tea, syrup or extract.

Utz von Hutten (1488-1523) suffered from syphilis. The Imperial Knight treated himself with the wood and wrote in 1519: “According to my observations, the medium (guaiac wood) works slowly and evenly, not quickly or stormily. Far from the fact that its healing effect is immediately felt subjectively or that it quickly relieves the pain that it finally completely eliminates, on the contrary, at the beginning of the cure and for the first fortnight, the disease becomes acute to the highest degree: take the torments to, the ulcers spread and in fact the patient feels as if he is worse than ever. ”And yet Hutten died at the age of 35 from the disease.

According to current findings, guaiac wood has an anti-inflammatory, spasmolytic and aquaretic effect. It does not work against bacteria and is therefore unsuitable for controlling Treponema pallidum. Syphilis runs in spurts and waves. Sick people like Hutten presumably took the wood in a phase of temporary recovery and pushed this improvement to the remedy.

Syphilis - differential diagnoses

  1. Primary syphilis can be confused with genital herpes and carcinoma.
  2. Secondary syphilis shows symptoms similar to HIV infection, floret lichen, psoriasis and drug allergies.
  3. The symptoms of neurosyphilis coincide with other forms of dementia caused by disorders in the central nervous system. However, this neurosyphilis precedes a decades-long course of syphilis.

Root cause

In Germany today, the cause is almost always unprotected sex with an infected partner. The risk of infection is high - it is around 50 percent. Oral sex without a condom with changing sexual partners and the use of anal sex toys, bandages, syringes etc. that are used by infected people are particularly dangerous.

How does syphilis develop?

Early syphilis lasts about a year after infection. The primary syphilis (syphilis I) is followed by the secondary syphilis (syphilis II). About a month after infection, a knot forms where the pathogen entered the body. Often, those affected do not notice this. It does not cause pain and is easily confused with other skin thickenings. The nodule creates an ulcer that is also painless, wets, and forms a cartilaginous margin. Since syphilis is transmitted primarily through sexual intercourse, this ulcer is located at the place of sexual practice: on the anus, in the colon, on the genital organs, in the mouth or on the lips.

Once the ulcer has formed, the nearby lymph nodes swell. During sexual intercourse, these are the lymph nodes in the groin area. Characteristic are the lack of pain and the lack of inflammation - in contrast to "typical", otherwise similar, thickening in the sex area. These are often caused by fungal or bacterial attack, so they ignite, itch and scratch.

Syphilis is a little "tricky" because the ulcer will go away on its own after up to six weeks. Most of the time, we assume that something that does not hurt, does not become inflamed and goes away on its own, is harmless and ignores it. But syphilis can now pass to the second stage - at least without treatment.

This second stage begins about eight to nine weeks after being infected. Now the pathogens have spread over the blood in the body. Those affected feel sick. You have a fever and the lymph nodes swell all over your body. The main symptom is a rash; the rash then turns into individual nodules, which flake above all on the hand and the soles of the feet and are reminiscent of psoriasis. The reddish nodules are foci of infection that contain the pathogen. However, like the initial ulcer, they do not cause pain.

In the secondary stage, various other complaints arise, from hair loss to growths in the oral mucosa to inflammation of the throat, itchy, small wart-like structures on the genital organs and on the anus. This second stage can last for years if left untreated. Sometimes the disease ends on its own - which in the past led to belief in the effectiveness of really ineffective means.

The tertiary stage does not begin until three to five years after the infection, and now it becomes dangerous. Not only are the skin and lymph nodes affected by the bacteria, but also the organs - from the stomach to the intestine to the esophagus, bones and muscles. Finally, an aortic aneurysm can develop several decades after the infection, whereby this blood vessel is diseased. If it tears, which can easily happen, there is a heavy internal bleeding and this can lead to death within a short time. This third stage can be avoided today with antibiotic therapy.

Some physicians consider neurosyphilis to be part of the third stage, but can also be separated into a quaternary stage, since it only develops after ten to 20 years. Now the bacteria also affect the central nervous system. Paralysis from the damage to the spinal cord threatens, but above all an irreversible deterioration of mental faculties up to dementia. In industrialized countries, this last stage only occurs due to errors in the treatment and disregard for the previous illness. In the third and fourth stages, syphilis is no longer contagious.

Particular dangers

Pregnant women infected with syphilis can transmit the pathogen to the unborn child. In the case of a freshly caught disease, this happens to 80 to 90 percent, still with a probability of 40 percent in the secondary stage and with ten percent in the third stage. Sick mothers often suffer from miscarriages and premature births.

The first stage ulcer is a gateway for HIV infection. If those affected are now additionally infected with HIV, syphilis in HIV will accelerate the course of the disease. Combined syphilis and HIV infections also promote the outbreak of dangerous neurosyphilis.


The “pleasure epidemic” that terrified early modern Europe and fueled church propaganda against sexual self-determination can not only be prevented by protected traffic, but can also be treated well after the outbreak. Treatment with penicillin or other antibiotics in the first and second stages is usually successful - and there is no permanent damage.

Penicillin G is the best antidote, however, the syphilis pathogens multiply slowly, and therefore the treatment must be given in high doses over two weeks, in later phases of syphilis even up to three weeks. Injections into the muscles are sufficient in the initial stage, while intravenous injections over three weeks are inevitable in the third stage. Neurosyphilis needs to be treated even more intensely with penicillin.

Those affected must not have sexual intercourse until the healing process and must not breastfeed babies. In the first year, a medical check is carried out every three months to determine whether pathogens are still present, and then once a year thereafter.

Treatment complications

Problematic reactions to penicillin therapy are rare and require treatment with other antibiotics. However, every second affected person shows severe reactions due to the rapid disintegration of the syphilis pathogens, which are referred to as the Jarisch-Herxheimer reaction. Since these reactions arise when the pathogen is destroyed, they cannot be stopped. It is pain in the head and muscles, fever, chills, and a drop in blood pressure. They start two to eight hours after the penicillin injection. To relieve the symptoms, those affected receive cortisone.

Syphilis in Germany today

Syphilis is spreading again in Germany. A total of 7,476 cases of syphilis were reported to the Robert Koch Institute in 2017, 4.2 percent more than in 2016. Since 2010, the number of sufferers has increased continuously. Homosexual men are particularly affected. The number of infected people who contracted sexual contact with other men was 83.5 percent.

One possible reason is that "safer sex" practices are subsiding again and intercourse without condoms is increasing, which in turn has to do with the fact that HIV has become more and more treatable in recent decades. The big shock of "deadly lust" that shook the 1980s and led to condom use becoming standard is over. Safe sex to prevent HIV also prevented other sexually transmitted diseases such as syphilis. The most important method against HIV helps to prevent syphilis: safe sex. Use condoms, do not share sex toys, or at least wash them thoroughly before use. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.


  • Robert Koch Institute: RKI Guide Syphilis (accessed: June 26, 2019), rki.de
  • Deutsche Aidshilfe e.V .: Syphilis (accessed: June 26, 2019), aidshilfe.de
  • Professional Association of Gynecologists (BVF): Syphilis (accessed: June 26, 2019), Frauenaerzte-im-netz.de
  • Merck & Co., Inc .: Syphilis (accessed: June 26, 2019), msdmanuals.com
  • German STI Society e. V. (DSTIG): S2K guideline on syphilis, diagnostics and therapy, as of July 2014, detailed guideline view
  • Austria's public health portal: Syphilis (accessed: June 26, 2018), gesundheit.gv.at
  • Mayo Clinic: Syphilis (accessed: June 26, 2018), mayoclinic.org
  • World Health Organization: WHO guidelines for the treatment of Treponema pallidum (syphilis), status: 2016, who.int

ICD codes for this disease: A50, A51, A52, A53ICD codes are internationally valid encryption for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.

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